Dr. Jonathan Letterman had devised, implemented and had gained success with a well-trained ambulance corps. Then he turned his attention to medical practices itself.
Civil War Doctors and their Equipment
By 1860s, medical practice in America had barely evolved since colonial times. In Europe, however, both Louis Pasteur and Joseph Lister were poised to revolutionize medicine with their concepts of bacteria, germs and antisepsis. Nevertheless it would be decades before those theories were accepted as science in the United States.
During the Civil War, medical doctors with varying degrees of training and competency enlisted in the both North and South. In the South, which was desperately in need of any amount of medical expertise, all doctors were welcomed. In the North, however, there was a rigorous hierarchy of army surgeons, medical doctors, assistant doctors and even nurses. The animosity and friction it caused was understandable, but it was frustrating.
Dr. Jonathan Letterman, who had a decade of experience as an army surgeon out West, was not about to brave the shoals of in-fighting, especially since doctors were urgently needed. He was, however, prepared to implement two system to improve the mechanics of medical practice, both of which were readily executed and accepted enthusiastically by the Army itself as well as the doctors.
The Civil War Medical Kit
Most army doctors, whether from within the Army Corps itself or as private recruits, brought their own instruments at the start of the Civil War. Some of those instruments were antiquated. Some were in dire need of repair. Unsurprisingly, many were lost or damaged in transport and on the battlefield. A good many were inadequate to treat the types of wounds inflicted by the bone-shattering minie balls.
Dr. Letterman’s prior experience as an army surgeon had inspired him to develop a list of basic medical tools that he believed were necessary to treating battlefield casualties. He believed wholeheartedly that a standardized kit was essential, along with a fully equipped medical wagon-per-brigade. Then the instruments could easily be transported, and more importantly, replaced if and when needed. Every doctor would then be equipped with all the tools he needed to meet all possible situations.
These medical kits contained various sizes and shapes of knives, scalpels, forceps, bistouries (long, narrow knives for minor incisions), curettes for scraping and cleaning, and lancets for making punctures. In addition, there were tourniquets, bone saws, chain saws, sutures and bandages.
Each medical wagon was outfitted to contain seventy-six different medicines, dressings, medical books, and additional surgical instruments. They were further equipped with bedding, basins, vials, bedpans, basic food staples (hardtack and beef stock), kettles, plates, drinking vessels and spoons. When the extravagance of these supplies was raised, Letterman is said to have responded, “Lost supplies can be replaced, but lives lost are gone forever.”
Letterman’s Final Reform: The Field Hospital System
Shortly after the Second Battle of Bull Run (Manassas), Dr. Letterman introduced and implemented a system to provide a “dressing” station at the front, headed by one assistant surgeon from each regiment. Their purpose was to perform basic “triage”, and tend to immediate first aid and/or minor wounds.
The remainder of the medical staff would be organized into teams, and divisional field hospitals would be set up a few miles behind the lines. While people today are appalled by the lack of sanitation, it was a huge improvement over previous conditions. With hundreds, and frequently thousands of casualties brought to these makeshift facilities, only the most skilled physicians would be permitted to perform surgery. It would be left to the others to dress wounds, handle the record-keeping, supply maintenance, etc.
Throughout the North, the precursor to today’s VA Hospitals were established for long-term care, which included battlefield illnesses and/or providing prosthetic limbs, etc. These would be solid permanent structures, rather than tents or makeshift facilities at the front.
While some doctors groused and complained that their experience was being slighted, both the Army and the senior medical professionals agreed that it was “a brilliant achievement in hospital management,” despite the lack of sanitation. Countless lives were no doubt saved.
Dr. Letterman’s models for Ambulance Corps, a standardized medical kit and wagon, and field hospital management would be the model for armies throughout the world for the next half century.
Henig, Gerald S. and Niderost, Eric – Civil War Firsts: The Legacies of America’s Bloodies Conflict, Stackpole Books, 2001